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Souadka A, Essangri H, Majbar MA, Benkabbou A, Boutayeb S, Amrani L, Ghannam A, El Ahmadi B, Belkhadir ZH, Mohsine R, Souadka A, Elias D.

Cancers (Basel). 2021 Mar 3;13(5):1088.

Implementing a multimodal management of peritoneal surface malignancies is a steep and complex process, especially as complete cytoreductive surgery (CRS) is the backbone and the major prognostic factor for hyperthermic intraperitoneal chemotherapy (HIPEC) procedures. The implementation of such a program is a challenging process, particularly in low-middle income (LMIC) countries where ressource restrictions may represent a major hurdle to HIPEC appliances acquisition. Herein is the first audit of the implementation of a national peritoneal malignancy program in a north African country. The audit process was performed according to the three implementation steps, namely initiation (« 1 »:2005-2008), transition (« 2 »:2009-2013) and consolidation (« 3 »:2014-2017). We included all consecutive CRS without HIPEC performed with curative intent for ovarian, gastric, colorectal and pseudomyxoma peritonei type of malignancies with an Eastern Cooperative Oncology Group (ECOG) performance Status ≤ 2. Target outcomes for incomplete cytoreduction (ICRS), serious complications ≥ 3b according to the Clavien-Dindo scoring, and early oncologic failure (EOF; disease progression within 2 years of treatment) were compared between the three phases. Independent risk factors correlated to these three outcomes were calculated using a logistic regression model.198 CRS procedures were completed with 49, 60 and 89 cases performed in the three phases, respectively. Overall, patients were comparable except for ECOG and ASA scores which were more severe in the third phase. The comparison of ICRS, serious complications and EOF rates showed a significant reduction between the three phases with (34%, 18% and 4% p = <0.001), (30.6%, 20% and 11.2%, p = 0.019) and (38.8%, 23.3% and 12.4% p = 0.002) respectively. Undergoing CRS in phase 3 on the other hand was a predictive factor of better short term surgical and oncological outcomes and completeness of cytoreduction, while ECOG performance status and spleno-pancreatectomy were also predictive factors of serious complications.

Oncologist. 2011;16(7):1021-7. doi: 10.1634/theoncologist.2011-0007. Epub 2011 Jun 9.

Uzan C(1), Souadka A, Gouy S, Debaere T, Duclos J, Lumbroso J, Haie-Meder C, Morice P.

Department of Surgery, Institut Gustave Roussy and University Paris Sud, Villejuif Cedex, France. 

BACKGROUND: Laparoscopic para-aortic lymphadenectomy (PAL) is being used increasingly to stage patients with locally advanced cervical cancer (LACC) and to define radiation field limits before chemoradiation therapy (CRT). This study  aimed to define clinical implications, review complications, and determine whether surgical complications delayed the start of CRT.

METHODS: We retrospectively reviewed a continuous series of patients with LACC, with no positive para-aortic (PA) nodes on positron emission tomography-computed  tomography (PET-CT) and who had undergone a primary laparoscopic PAL.

RESULTS: From November 2007 to June 2010, 98 patients with LACC underwent pretherapeutic PAL. Two patients did not undergo PAL: extensive carcinomatosis was discovered in one case and a technical problem arose in the other. No perioperative complications occurred. Seven patients had a lymphocyst requiring an imaging-guided (or laparoscopic) puncture. Eight patients (8.4%, which corresponds to the false-negative PET-CT rate) had metastatic disease within PA lymph nodes. In cases of suspicious pelvic nodes on PET-CT, the risk for PA nodal disease was greater (24.0% versus 2.9%). When patients with and without surgical morbidity were compared, the median delay to the start of treatment was not significantly different (15 days; range, 3-49 days versus 18 days; range, 3-42 days).

CONCLUSIONS: The morbidity of laparoscopic PAL was limited and the completion of treatment was not delayed when complications occurred. Nevertheless, if PET-CT of the pelvic area is negative, the interest in staging PAL could be discussed because the risk for PA nodal disease is very low.

DOI: 10.1634/theoncologist.2011-0007

PMID: 21659610  [Indexed for MEDLINE]


Mouaqit O(1), Jahid A, Ifrine L, Omar El Malki H, Mohsine R, Mahassini N, Belkouchi A.


Author information:

(1)Surgery Departement A, Ibn Sina University Hospital, Rabat, Morocco.


Gastrointestinal stromal tumors (GISTs) represent the majority of primary non-epithelial neoplasms of the digestive tract, most frequently expressing the KIT protein detected by immunohistochemical staining for the CD117 antigen. Extragastrointestinal stromal tumors (EGISTs), neoplasms with immunohistological  features overlapping those of GISTs, are found in the abdomen outside of the gastrointestinal tract with no connection to the gastric or intestinal wall. The  present report presents the clinical, macroscopic and immunohistological features of an EGIST arising in the greater omentum of a 63-year-old woman, and discusses  the clinical behavior and prognostic factors of such lesions in comparison to their gastrointestinal counterparts.


Copyright © 2011 Elsevier Masson SAS. All rights reserved.


DOI: 10.1016/j.clinre.2010.11.012

PMID: 21349787  [Indexed for MEDLINE]


Clin Res Hepatol Gastroenterol. 2011 Sep;35(8-9):590-3. doi: 10.1016/j.clinre.2010.11.012. Epub 2011 Feb 23.

Honoré C(1), Souadka A, Goéré D, Dumont F, Deschamps F, Elias D.


Author information:

(1)Department of Surgical Oncology, Institut Gustave Roussy, Cancer Center, Villejuif, France.


PURPOSE: To report the incidence of urinary tract procedures performed during complete cytoreductive surgery (CCRS) plus intraperitoneal chemotherapy, and to report the types of procedure, specific morbidity, risk factors, and treatment.

METHODS: Data were extracted from a prospective database of patients with malignant peritoneal disease treated with CCRS plus intraperitoneal chemotherapy  who had undergone a resection or suture of the bladder, ureter, or kidney. Patients were eligible whatever the tumor origin.

RESULTS: Between 1994 and 2010, among the 598 patients treated with CCRS plus intraperitoneal chemotherapy, 48 (8%) had undergone a resection or suture in the  urinary tract. Procedures included 4 nephrectomies, 19 partial cystectomies, 8 surgically repaired bladder injuries, and 18 ureteral resections. Postoperative mortality was 4% and morbidity was 41%. Specific complications included 6 urinary fistulas (12%), two among the 27 bladder sutures (7%) and four among the 18 ureteral sutures (22%) (P = NS). In the multivariate analysis, the risk factors for urinary fistula were severe preoperative malnutrition (P = 0.05, relative risk [RR] = 7.3) and extensive peritoneal disease (peritoneal cancer index ≥20, P = 0.05, RR = 8.3). Urinary fistulas had been treated nonsurgically in most of the cases.

CONCLUSIONS: Associated urinary tract procedures had occurred in 8% of the cases  but did not greatly increase morbidity. Therefore, urinary tract involvement or injury are not contraindications to performing CCRS plus intraperitoneal chemotherapy. Fistulas had complicated only 12% of urinary sutures, mainly in cases of malnutrition or extensive peritoneal disease.


DOI: 10.1245/s10434-011-1820-2

PMID: 21638092  [Indexed for MEDLINE]


Ann Surg Oncol. 2012 Jan;19(1):104-9. doi: 10.1245/s10434-011-1820-2. Epub 2011 Jun 3.

Elias D(1), Souadka A, Fayard F, Mauguen A, Dumont F, Honore C, Goere D.

Author information:

(1)Department of Surgical Oncology, Institut Gustave Roussy, Rue Camille Desmoulins, 94805 Villejuif, France.

INTRODUCTION: The prognosis of peritoneal carcinomatosis (PC) is highly dependent on the extent of the PC. This extent is calculated by the peritoneal cancer index (PCI). In the future, the indications for complete cytoreductive surgery (CRS) +  hyperthermic intraperitoneal chemotherapy (HIPEC) should be partially based on the PCI. This raises the question of the concordance between the PCI scores calculated by different surgeons, and a possible variation before and after CRS.

OBJECTIVE: To analyze variations in the PCI score between surgeons and according  to when it is determined (before and after surgery).

PATIENTS AND METHODS: Prospective recording of the PCI score independently calculated by senior and junior surgeons, before CRS (when the surgeon decided to perform this procedure), and after CRS, in 75 consecutive patients. A concordance analysis was conducted.

RESULTS: The origins of the PC were colorectal (n = 38), pseudomyxoma (n = 22), mesothelioma (n = 8) and miscellaneous lesions (n = 7). Concordance between the PCI score was very high (close to 90%) among the senior surgeons and junior surgeons before and after CRS. After CRS, the mean PCI score increased by 1.75 (IC-95%: 2.09-1.41). This high concordance was similar whatever the level of the  PCI score and whatever the origin of the tumor.

CONCLUSION: The PCI is a reliable tool for measuring the extent of PC. It is easy to use and inter-surgeon concordance is high. It increases by approximately 2 before and after CRS.

Copyright © 2012 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ejso.2012.01.001

PMID: 22281154  [Indexed for MEDLINE]

Eur J Surg Oncol. 2012 Jun;38(6):503-8. doi: 10.1016/j.ejso.2012.01.001. Epub 2012 Jan 26.

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